European Journal of Pediatrics最新文献

{"title":"Lactate-albumin ratio as an early predictor of mortality in critically ill children: A prospective cohort study.","authors":"Hari Prasath C, P Anil Kumar","doi":"10.1007/s00431-026-07525-x","DOIUrl":"https://doi.org/10.1007/s00431-026-07525-x","url":null,"abstract":"<p><p>Early risk stratification in critically ill children relies on severity scores such as PRISM-III and PELOD-2, requiring multiple variables. The lactate-albumin ratio (LAR), a two-parameter marker, shows prognostic value in adult and paediatric critical illness. This study evaluated serial LAR for predicting PICU mortality and compared its performance at admission against PRISM-III and PELOD-2. This prospective cohort study enrolled 335 of 563 screened children aged 1 month to less than 13 years admitted to a tertiary-care PICU in South India over 12 months. Serum lactate and albumin were measured at 0, 12, 24, and 48 h. Discriminatory performance was assessed using ROC curve analysis with DeLong's test. Firth-penalized multivariable logistic regression identified independent predictors. Of 335 children, 42 (12.5%) were non-survivors. LAR at admission discriminated mortality with an area under the curve (AUC) of 0.859 (95% CI 0.806-0.907), exceeding PRISM-III (AUC 0.751) and PELOD-2 (AUC 0.759) at the same timepoint (p < 0.05 for both). LAR remained independently associated with mortality after adjustment for PRISM-III, sepsis, and vasoactive support (adjusted odds ratio 3.77, 95% CI 2.22-6.40, p < 0.001), and outperformed lactate and albumin. LAR remained persistently elevated in non-survivors through 48 h.Conclusions: LAR at admission discriminated PICU mortality better than PRISM-III and PELOD-2 and remained an independent predictor after adjustment. Serial LAR changes may be a useful adjunct in predicting prognosis, though their clinical utility requires further prospective study. Derived from two routine investigations, LAR may serve as a practical addition to severity scoring, pending external validation. What is Known • Mortality risk in critically ill children is estimated with multivariable severity scores such as PRISM-III and PELOD-2. • Lactate and albumin refl ect tissue perfusion and systemic infl ammation, and their ratio has been associated with mortality in critical illness. What is New • We hypothesised that the lactate-albumin ratio, from two routine blood tests, may predict PICU mortality at least as well as multivariable severity scores. • We also hypothesised that serial measurement over the fi rst 48 hours may add prognostic information beyond the admission value.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Venous Excess Ultrasound Score (P-VExUS): a novel approach to assess central venous pressure in the PICU.","authors":"Fernando de Lima Carioca, Nayara Hillebrand Franzon, Lívia da Silva Krzesinski, Isabel de Siqueira Ferraz, Roberto José Negrão Nogueira, Tiago Henrique De Souza","doi":"10.1007/s00431-026-07515-z","DOIUrl":"10.1007/s00431-026-07515-z","url":null,"abstract":"<p><p>Accurate assessment of central venous pressure (CVP) in critically ill children is important for guiding fluid management but remains challenging, as invasive monitoring is not always feasible and noninvasive tools are limited. We aimed to develop and validate pediatric adaptations of the Venous Excess Ultrasound Score (P-VExUS) for bedside estimation of CVP in mechanically ventilated children. This prospective observational study was conducted in a tertiary-care PICU. Fifty-six mechanically ventilated children were included. Venous Doppler ultrasonography of the inferior vena cava, hepatic, portal, and intrarenal veins was performed at the bedside. Two P-VExUS models were evaluated: (1) a categorical grading system (0-III) and (2) a semiquantitative point-based score (0-7). Diagnostic performance was assessed for predefined, clinically relevant CVP thresholds reflecting low (< 7 mmHg) and elevated (> 12 mmHg) venous pressure states using receiver operating characteristic analysis. Both models were significantly associated with measured CVP. For predicting elevated CVP, model 1 showed an area under the receiver operating characteristic curve (AUROC) of 0.74 (95% CI 0.61-0.85), with 45% sensitivity and 98% specificity. Model 2 demonstrated superior accuracy (AUROC 0.94, 95% CI 0.84-0.98), with 82% sensitivity and 91% specificity (p < 0.001). For detecting low CVP, model 2 also outperformed model 1 (AUROC 0.80 vs. 0.69; p = 0.02). Intrarenal vein patterns had the highest discriminative ability (AUROC 0.92).</p><p><strong>Conclusion: </strong> Pediatric-specific P-VExUS models were feasible and accurate for estimating CVP in critically ill children. The point-based model showed superior diagnostic performance and may represent a promising noninvasive bedside tool for assessing venous congestion.</p><p><strong>What is known: </strong>• Elevated central venous pressure (CVP) is associated with adverse outcomes in critically ill children, including mortality and renal dysfunction. • Inferior vena cava-based ultrasound indices have limited accuracy for estimating CVP in mechanically ventilated children, while pediatric adaptations of the Venous Excess Ultrasound Score (VExUS) remain poorly defined.</p><p><strong>What is new: </strong>• This study proposes and evaluates two pediatric adaptations of VExUS, demonstrating superior diagnostic performance of a point-based model for identifying elevated (12 mmHg) and low (7 mmHg) CVP. • Intrarenal venous Doppler showed the highest individual discriminative performance, suggesting potential simplification of venous congestion assessment in critically ill children.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic timing in cerebral creatine deficiency syndromes: neurodevelopmental and genetic characterization of a multicenter cohort.","authors":"Mehmet Akif Kilic, Volkan Karaman, Pinar Gencpinar, Ayfer Sakarya Gunes, Fatma Mujgan Sonmez, Halil Ibrahim Aydin, Olgay Bildik, Safiye Gunes Sager, Tugce Aksu Uzunhan, Cagatay Gunay, Ozlem Ates Yaman, Hakan Ercelebi, Gunce Basarir, Anil Gok, Melike Ersoy, Deniz Sunnetci Akkoyunlu, Hamza Polat, Ayberk Turkyilmaz, Betul Turan, Bulent Uyanik, Muhtesem Agildere, Hande Kaymakcalan Celebiler, Muhammed Mehtar, Nihal Olgac Dundar, Edibe Pembegul Yildiz, Bulent Kara, Hulya Maras Genc","doi":"10.1007/s00431-026-07519-9","DOIUrl":"10.1007/s00431-026-07519-9","url":null,"abstract":"<p><strong>Purpose: </strong>Cerebral creatine deficiency syndromes (CCDS) are rare inherited neurometabolic disorders comprising two creatine biosynthesis defects-guanidinoacetate methyltransferase (GAMT) and arginine:glycine amidinotransferase (AGAT) deficiencies-and creatine transporter (CRTR) deficiency. Because early diagnosis and presymptomatic treatment are critical, particularly in biosynthesis defects, this study aimed to delineate the clinical features, diagnostic timing, and genetic spectrum of CCDS, and to describe the outcomes of presymptomatically treated patients.</p><p><strong>Methods: </strong>This was a retrospective, multicenter cohort study. Clinical, radiological, biochemical, and genetic data were reviewed, and all variants were classified according to the gene-specific ClinGen CCDS Variant Curation Expert Panel specifications. Patients with pathogenic or likely pathogenic variants were considered genetically confirmed; patients whose variants remained of uncertain significance (VUS) were described separately and excluded from comparative analyses.</p><p><strong>Results: </strong>Of the 22 enrolled patients, 19 were genetically confirmed. Three presymptomatically treated patients with GAMT deficiency remained asymptomatic. Among the 16 symptomatic, genetically confirmed patients, the median diagnostic interval was 88.5 months (IQR 114; range 10-228). All symptomatic patients had global developmental delay or intellectual disability. Four novel variants were identified: the homozygous p.(Arg189His) variant (AGAT deficiency) was classified as likely pathogenic and the homozygous deletion c.242_327+63del (GAMT deficiency) as pathogenic; two hemizygous variants (CRTR deficiency), p.(Trp55Arg) and p.(Gly253Glu), remained VUS.</p><p><strong>Conclusion: </strong> Favorable neurodevelopmental outcomes in patients with GAMT deficiency treated before symptom onset underscore the importance of clinical awareness and timely diagnosis, and support the rationale for newborn screening. The two novel disease-causing variants expand the genetic spectrum of CCDS.</p><p><strong>What is known: </strong>• Cerebral creatine deficiency syndromes are rare inherited neurometabolic disorders comprising AGAT, GAMT, and CRTR deficiencies. • Presymptomatic treatment of GAMT deficiency can prevent irreversible neurodevelopmental sequelae.</p><p><strong>What is new: </strong>• Two novel disease-causing variants (likely pathogenic in AGAT deficiency; pathogenic in GAMT deficiency) expand the genetic spectrum; two novel SLC6A8 variants remain of uncertain significance under ClinGen CCDS Expert Panel criteria. • Favorable outcomes in three presymptomatically treated patients with GAMT deficiency support the rationale for newborn screening.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring children's perspectives on essential elements in a child-centred hospital environment: a descriptive qualitative approach.","authors":"Alexandra Cloostermans, Dorien Ulenaers, Jochen Bergs","doi":"10.1007/s00431-026-07502-4","DOIUrl":"https://doi.org/10.1007/s00431-026-07502-4","url":null,"abstract":"<p><p>Child-centred care emphasises children's active involvement in healthcare, grounded in dignity, respect, equity, privacy, and autonomy. Yet despite growing recognition of children's rights, their own perspectives remain underrepresented in the design of healthcare environments. This study operationalises child-centred care for the hospital setting by exploring what primary school children themselves consider important during a hospital stay, how they perceive the physical environment, and how far they wish to be involved in their care. Children attending the annual science day at Hasselt University (Belgium) were recruited through convenience sampling; parents observed the sessions, which were facilitated by design-thinking experts. A descriptive qualitative approach, informed by the LEGO® Serious Play® methodology, enabled children to express their experiences through creative modelling. Thematic analysis was used to identify core themes across the data. Twenty-three children took part in three focus groups. Their ages ranged from 6 to 13 years, with a median of 8 years. Children highlighted the importance of a colourful environment with outdoor access and open, transparent spaces. They valued engaging distractions-such as educational games or therapy animals-the continuous presence of loved ones, and a positive atmosphere shaped by supportive healthcare professionals. Nutrition was also important, with a clear preference for fresh food and vegetables. Desired levels of involvement varied, underscoring the need to ask each child how they wish to participate in their care. Safety emerged as a central concern: children suggested adding a severity indicator to the patient call system, and viewed hospitals as spaces that should be protected through measures such as surveillance cameras.</p><p><strong>Conclusion: </strong> Children express a need for hospital environments that integrate comfort, play, social connection, and safety, supported by an individualised, genuinely child-centred approach.</p><p><strong>What is known: </strong>• Evidence on child-centred care has largely been generated through family-centred or observational approaches, with limited direct input from children about their own experiences.</p><p><strong>What is new: </strong>• This study uses LEGO® Serious Play® to elicit children's perspectives directly, identifying their priorities for the physical environment, ambience, involvement in care, and safety. • They ask for hospital environments that combine comfort, play, social connection, and safety, delivered through an individualised, genuinely child-centred approach.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulatory blood pressure characteristics and left ventricular hypertrophy in untreated children with primary hypertension.","authors":"Kexin Zhu, Ruijuan Su, Jiao Yang, Guowen Liu, Liyuan Xu, Jingya Li, Yan Sun, Hongju Zhang, Shanshan Li, Yawen Deng, Zhen Ouyang, Ning Ma","doi":"10.1007/s00431-026-07530-0","DOIUrl":"https://doi.org/10.1007/s00431-026-07530-0","url":null,"abstract":"<p><p>To identify clinical and ambulatory blood pressure monitoring (ABPM)-derived factors associated with left ventricular hypertrophy (LVH) in untreated children and adolescents with primary hypertension. This retrospective study included 306 untreated patients aged 9-17 years with newly diagnosed primary hypertension. LVH was defined as a left ventricular mass index ≥ 45 g/m^2.16. Propensity score-based overlap weighting was used to balance demographic and obesity-related characteristics between patients with and without LVH. Weighted logistic regression was performed to evaluate clinical, laboratory, and ABPM-derived factors associated with LVH. LVH was present in 89 patients (29.1%). Grade 2 office hypertension was the strongest factor associated with LVH (OR 4.22, 95% CI 2.29-7.77; P < 0.001). Selected metabolic and inflammatory markers showed exploratory associations with LVH. Among continuous ABPM parameters, nighttime mean diastolic blood pressure was associated with LVH (OR 1.54 per 10-mmHg increase, 95% CI 1.02-2.31), although this association was lost after adjustment for hypertension grade. In contrast, a systolic non-dipper pattern remained associated with LVH after adjustment for hypertension grade (OR 2.83, 95% CI 1.18-6.80; P = 0.020).</p><p><strong>Conclusion: </strong> LVH was common among untreated children with primary hypertension, with office HTN severity being the predominant associated factor. Abnormal circadian BP patterns may provide complementary information for identifying children with LVH.</p><p><strong>What is known: </strong>• Left ventricular hypertrophy is a common form of cardiac target-organ damage in children with primary hypertension. • Ambulatory blood pressure monitoring provides information on nocturnal blood pressure and circadian patterns beyond office blood pressure.</p><p><strong>What is new: </strong>• In untreated children, grade 2 office hypertension was the factor most strongly associated with left ventricular hypertrophy. • A systolic non-dipping pattern remained associated with left ventricular hypertrophy after adjustment for hypertension severity, suggesting additional value of circadian blood pressure assessment.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of sleep-related breathing disorders and polysomnography findings in pediatric patients with achondroplasia.","authors":"Raziye Atan Habacı, Dilara Demirel, Nagehan Emiralioğlu, Meltem Akgül Erdal, Ebru Yalçın, Deniz Doğru, Gizem Ürel Demir, Eda Utine, Pelin Ozlem Simsek Kiper, Uğur Özçelik","doi":"10.1007/s00431-026-07531-z","DOIUrl":"https://doi.org/10.1007/s00431-026-07531-z","url":null,"abstract":"<p><strong>Purpose: </strong>To describe sleep-disordered breathing in children with achondroplasia at their first polysomnography (PSG) assessment and examine associations with clinical characteristics.</p><p><strong>Methods: </strong>This retrospective study included 49 children evaluated between March 2016 and February 2025. Obstructive sleep apnea syndrome (OSAS) was classified using the obstructive apnea-hypopnea index (oAHI). Total AHI was compared according to sex, upper airway surgery history, foramen magnum stenosis, and vosoritide treatment. Infant findings were also presented separately because severity thresholds require cautious interpretation at this age.</p><p><strong>Results: </strong>Median age was 4.48 years (range, 0.22-16.15). OSAS was identified in 39 children (79.6%); 25 (51.0%) met the study criteria for moderate-to-severe disease. Of 15 children without reported sleep-related symptoms, 12 (80.0%) had OSAS, including seven (46.7%) with moderate-to-severe disease. Three children had a central apnea index ≥ 5 events/hour, and two (4.1%) had nocturnal hypoventilation. Total AHI did not differ significantly by sex, surgery history, or foramen magnum stenosis. Median total AHI was 3.2 events/hour in children receiving vosoritide and 6.9 in those not receiving treatment (p = 0.105).</p><p><strong>Conclusion: </strong>OSAS was common at the first PSG assessment and was also found in children without reported symptoms. These findings support objective sleep assessment in achondroplasia. The retrospective design and age-dependent interpretation of infant PSG limit conclusions about prevalence and severity; the study cannot establish a respiratory effect of vosoritide.</p><p><strong>What is known: </strong>• Achondroplasia increases the risk of obstructive and central sleep apnea. • Reported symptoms may not reliably identify sleep-disordered breathing.</p><p><strong>What is new: </strong>• At first PSG, 12/15 children without reported symptoms had OSAS; 7 had moderate-to-severe disease. • Total AHI did not differ significantly by vosoritide treatment status.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epididymal cysts in children: a systematic review and meta-analysis of treatment approaches and clinical outcomes.","authors":"Ugo Maria Pierucci, Rianne J M Lammers, Yesica Quiroz Madarriaga, Muhammet Irfan Dönmez, Ismail Selvi, Christa Gernhold, Numan Baydilli, Beatriz Bañuelos Marco, Quinten Bogaerts, Adree Khondker, Vasileios Tatanis, Lisette Aimee 't Hoen","doi":"10.1007/s00431-026-07501-5","DOIUrl":"10.1007/s00431-026-07501-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To systematically synthesise current evidence on the epidemiology, clinical characteristics, natural history, and outcomes reported under different management approaches for epididymal cysts (ECs) in boys.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A PRISMA 2020-compliant systematic review was conducted using PubMed, Embase, and Scopus from inception through 31 August 2026. Observational studies including males younger than 18 years with ECs and reporting clinical outcomes were eligible. Random-effects meta-analyses of single-arm proportions were performed for key prevalence outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Nine retrospective studies published between 2002 and 2025 were included, comprising 492 paediatric patients. No controlled comparative studies were identified. ECs were most frequently detected incidentally or during evaluation for painless scrotal swelling. Lesions were predominantly unilateral (79-90%), most were located in the epididymal head, and reported cyst size ranged from 2 to 40 mm. Associated conditions included hydrocele, varicocele, and testicular microlithiasis, with no reported link to malignancy. Conservative management was the preferred initial strategy in contemporary cohorts, whereas earlier series reported higher surgical rates. Surgery was mainly indicated for persistent pain or progressive enlargement and involved open excision, with high rates of symptom resolution and low reported morbidity. Meta-analysis showed that bilateral cysts occurred in 8% (95% CI 7-9%; I&lt;sup&gt;2&lt;/sup&gt; = 12.5%) of patients, complete spontaneous regression occurred in 12.2% (95% CI 8.3-16.1%; I&lt;sup&gt;2&lt;/sup&gt; = 88.1%), and 7.4% (95% CI 3.1-11.7%; I&lt;sup&gt;2&lt;/sup&gt; = 94.7%) of children required surgery. Postoperative complications were uncommon (3.4%; 95% CI 1.1-5.6%; I&lt;sup&gt;2&lt;/sup&gt; = 0%), and reported torsion events were rare (1.6%; 95% CI 0.7-2.5%; I&lt;sup&gt;2&lt;/sup&gt; = 0%); the available data did not establish that ECs predispose to testicular torsion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Paediatric ECs are benign lesions with a favourable natural history. Many lesions remain clinically stable, while complete spontaneous regression occurs in a minority. A conservative-first approach is appropriate in most cases, reserving surgery for selected patients with persistent symptoms, clinically meaningful enlargement, or diagnostic uncertainty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is known: &lt;/strong&gt;• Epididymal cysts in children are benign extratesticular lesions, usually detected incidentally and commonly managed conservatively. • Surgical indications and follow-up strategies remain inconsistent across paediatric studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is new: &lt;/strong&gt;• To the best of our knowledge, and on the basis of the searches performed, this is the first systematic review and meta-analysis specifically evaluating paediatric ECs. • Our findings support a conservative-first approach, with low rates of surgery and reported complications, and question the value of r","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Bacterial bloodstream infections in pediatric oncology patients in a tertiary medical center: pathogen distribution, antimicrobial nonsusceptibility, and outcomes.","authors":"Menucha Jurkowicz, Eugene Leibovitz, Hila Rosental, Nathan Keller, Gilad Sherman, Efrat Dresner, Guy Katzenellenbogen, Elina Gelman, Michal Paret, Reut Myaskovetzky-Yitshack, Hana Golan, Assaf Barg, Amos Toren, Michal Stein","doi":"10.1007/s00431-026-07499-w","DOIUrl":"10.1007/s00431-026-07499-w","url":null,"abstract":"","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal management and delivery-room stabilization in congenital complete heart block: an 11-year experience at a tertiary center.","authors":"Susana Elena Zeballos Sarrato, Teresa Álvarez Martín, Isabel Pescador Chamorro, Gonzalo Zeballos Sarrato, Dorotea Blanco Bravo, Manuel Sánchez Luna","doi":"10.1007/s00431-026-07532-y","DOIUrl":"https://doi.org/10.1007/s00431-026-07532-y","url":null,"abstract":"<p><p>Congenital complete heart block (CCHB) is a rare condition associated with significant perinatal hemodynamic instability. Although advances in prenatal diagnosis and pacing have improved survival, evidence guiding delivery-room stabilization remains limited. To describe our institutional experience in the perinatal management of CCHB, focusing on delivery-room stabilization and neonatal outcomes. We conducted a retrospective study at a tertiary center including newborns with CCHB over an 11-year period (2009-2020). Fetal characteristics, delivery-room interventions, and neonatal outcomes were analyzed. In 2014, a structured delivery-room stabilization protocol was introduced, incorporating ECG monitoring, anticipatory preparation for respiratory support and intravenous isoproterenol, and immediate availability of transcutaneous pacing (TCP) when indicated. Fourteen newborns were diagnosed with CCHB, with prenatal diagnosis in 13/14. Major congenital heart defects (CHD) were present in 3/14 newborns, and nine cases were immune-mediated. Prematurity occurred in 9/14. Respiratory support in the delivery room was required in 10/14 infants. Two infants with severe cardiorespiratory instability required intubation, TCP, and isoproterenol in the delivery room. Following NICU admission, invasive mechanical ventilation was required in 5/14 infants and inotropic support in 6/14. Invasive pacing was required in 9/14 infants, including 3/14 within the first 24 h of life. One patient required ECMO support. Survival to neonatal discharge was 13/14.Conclusion: Newborns with CCHB may require advanced stabilization at birth. A structured delivery-room strategy may incorporate anticipatory respiratory and hemodynamic support, including TCP in selected unstable newborns. Multidisciplinary coordination and CCHB-specific delivery-room planning provide a framework for anticipating potential stabilization needs. What is Known • Congenital complete heart block is associated with significant perinatal morbidity and may require early pacing. • Standard neonatal resuscitation algorithms may be insufficient in these patients. What is New • This study describes an 11-year experience with perinatal management and delivery-room stabilization of newborns with CCHB. • A CCHB-specific strategy integrating anticipatory cardiorespiratory support and transcutaneous pacing in selected unstable newborns is proposed as a pragmatic framework for delivery-room stabilization.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The PVL threat: A multicenter, single-cohort retrospective study of Panton-Valentine leukocidin staphylococcal infections in critically ill children.","authors":"Ivonne Portaccio, Ezio Bonanomi, Giovanna Chidini, Camilla Rigotti, Maria Luisa Ventura, Daniele Boghi, Valentina De Giorgis, Tony Christian Morena, Enzo Picconi, Letizia Capasso, Francesco Raimondi, Donatella Fortarezza, Raffaella Esposito, Chiara Borromeo, Imma Rulli, Eloisa Gitto, Rita Murri, Maria Maddalena Bitondo, Rodolfo Gualtieri, Daniela Puscio, Gennaro De Pascale, Marco Piastra","doi":"10.1007/s00431-026-07495-0","DOIUrl":"10.1007/s00431-026-07495-0","url":null,"abstract":"<p><p>Staphylococcus aureus carrying the Panton-Valentine leukocidin (PVL) genes, in both methicillin-susceptible (MSSA) and methicillin-resistant (MRSA) strains, causes severe infection in previously healthy children. We described critically ill children with PVL-positive infection and explored predictors of prolonged intensive care. In this multicenter, single-cohort retrospective study, we included 44 consecutive children aged 0-16 years with PVL-producing S. aureus infection admitted to a neonatal or pediatric intensive care unit (PICU) at 13 Italian centers between 2022 and 2025. The primary outcome was PICU stay above the cohort median. We used Fisher exact tests and exploratory Firth penalized logistic regression, overall and within age strata, with sensitivity analyses. Median age was 22 months (interquartile range [IQR] 11-123); 5 children (11%) were neonates. MSSA caused 25 cases (57%) and MRSA 19 (43%). Necrotizing pneumonia predominated, with excavation in 34 children (77%). Empyema (52%), acute respiratory distress syndrome (41%), pneumothorax (36%) and septic shock (34%) were the leading complications; 41 children (93%) required respiratory support and 4 (9%) extracorporeal membrane oxygenation. Median PICU stay was 17 days (IQR 10-28); 2 children died (5%). Septic shock was associated with prolonged stay (odds ratio 7.2; 95% CI 1.5-49.3), also after adjustment in children ≥ 1 year (adjusted odds ratio 8.0; 95% CI 1.3-49.8), with consistent but imprecise sensitivity analyses.</p><p><strong>Conclusion: </strong>PVL-producing S. aureus caused life-threatening infection at all pediatric ages. Methicillin resistance was not associated with prolonged stay, supporting PVL testing of S. aureus isolates from critically ill children. Predictors of prolonged stay are exploratory and need prospective confirmation.</p><p><strong>What is known: </strong>• PVL-producing S. aureus causes necrotizing pneumonia and disseminated infection in previously healthy children. • Evidence rests largely on case reports and small series, and infants are underrepresented.</p><p><strong>What is new: </strong>• In 44 critically ill children, including 5 neonates, MSSA and MRSA produced comparable critical illness. • In exploratory analyses, septic shock was associated with prolonged intensive care; mortality was 5%.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}